1710141833 NPI number — LARIMORE CHIROPRACTIC & MASSAGE LLC

Table of content: BRIAN DAVID MORALES DIAZ (NPI 1558074146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710141833 NPI number — LARIMORE CHIROPRACTIC & MASSAGE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LARIMORE CHIROPRACTIC & MASSAGE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710141833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1225 KEN PRATT BLVD
Provider Second Line Business Mailing Address:
SUITE 222
Provider Business Mailing Address City Name:
LONGMONT
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80501-6518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-772-3100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1225 KEN PRATT BLVD
Provider Second Line Business Practice Location Address:
SUITE 222
Provider Business Practice Location Address City Name:
LONGMONT
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80501-6518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-772-3100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DEPLER
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CA
Authorized Official Telephone Number:
720-494-0708

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4414 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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